Search Results (290)

Introduction: Pediatric palliative care (PPC) improves symptom management and end-of-life (EOL) outcomes. Disparities exist in access to PPC and EOL care related to social determinants of health. Less is known regarding how the content of PPC visits varies by sociodemographic factors like race/ethnicity, socioeconomic status, and language. Methods: This retrospective cohort study included patients 0–27 years old with cancer receiving PPC between 2017 and 2022. After each PPC visit, the documenting clinician selected the domains of care addressed during the visit (Goals of Care, Symptom Management, and Care Coordination with respective subdomains). Differences in frequency of subdomains discussed were compared across patient race/ethnicity, social deprivation index (SDI) score, language, and concordance with clinician race/ethnicity. Chi-square or Fisher’s exact test assessed differences in proportions of visits with each subdomain discussed, and Kruskal–Wallis tests assessed differences in the frequency of total subdomains discussed. Results: Among 467 patients, there were 7548 PPC visits. Most patients were non-Hispanic (n = 384, 82.2%), English-speaking (n = 425, 91.0%), and identified as White (n = 270, 57.8%) or Black (n = 166, 35.5%). A median of 8 (IQR 7, 11) subdomains were addressed per visit. One more subdomain was addressed in non-Hispanic White visits (9) compared to all other races/ethnicities (8, p < 0.001). Certain topics, like symptoms (e.g., nausea/vomiting), were more likely to be addressed in visits with White and Hispanic/Latino patients. One more subdomain was addressed in the intermediate disadvantage group (9, IQR 7, 11) compared to high and low disadvantage (8, IQR 7, 11) (p = 0.092). Both English- and non-English-speaking visits addressed a median of 8 subdomains (p < 0.001). One more subdomain was addressed in patient/clinician race-discordant (9, IQR 7, 11) than race-concordant encounters (8, IQR 7, 10) (p < 0.001). Conclusions: While EOL outcomes often differ for groups of different races, ethnicities, social deprivation indices, and languages, the frequency of subdomains discussed during PPC visits was fairly similar across groups. Disparities in PPC and EOL outcomes likely emerge from a complex interplay of variables beyond visit content, including health literacy, patient preference, historical context, and systemic factors. Full article

Introduction: Cancer pain remains a critical issue for patients’ quality of life, affecting their physiology, psychology, and social relationships. Despite the widely recognized role of pharmacists in pain management, their involvement in palliative care in Greece remains limited. This study focuses on exploring the perceptions and experiences of pharmacists regarding their role in cancer pain management, identifying barriers, required skills, and proposing strategies for their integration in the multidisciplinary team. Μaterials and Μethods: Qualitative research was conducted through semi-structured interviews with seven pharmacists in the Attica region. The interviews were recorded, transcribed, and thematically analyzed. Results: The analysis revealed four main themes: (1) limited access to medical records and challenges in pharmaceutical decision-making, (2) lack of institutional frameworks and a culture of collaboration, (3) need for specialized education and continuous training, and (4) understaffing and bureaucracy, faced by pharmacists. Discussion: This study highlights the underutilized role of pharmacists in cancer pain management in Greece. Barriers such as restricted access to patient records, weak interdisciplinary collaboration, insufficient training, and bureaucratic constraints limit their contribution. Structured frameworks and collaborative cultures can enhance pharmacists’ involvement, while education and continuous training are essential to strengthen their legitimacy within care teams. Digital tools can improve access to patient information and support evidence-based decisions. Conclusions: Pharmacists’ integration in the patient’s management team has significant benefits for the patient’s quality of life. Strengthening pharmacists’ involvement in cancer pain management requires the establishment of collaborations, continuous education, bureaucratic simplification, and the integration of digital tools. The development of practical resources, such as educational guides, can play a pivotal role in enhancing the quality of care provided. Full article

Background: A focused anamnesis of symptoms is essential in medical practice, especially in oncology, where new or increasing symptoms often indicate disease progression or therapy side effects. However, there are only a few studies in dermato-oncology that address the question of how symptoms should ideally be recorded. There are no validated questionnaires specifically tailored to the needs of dermato-oncology. Patients and Methods: Over a one-year period, all patients at the skin cancer centre were given a standardised questionnaire to record relevant symptoms before consultation. This was followed by the attending dermato-oncologist completing an additional section regarding therapeutic measures based on the reported symptoms. Results: 809 patients with 1879 consultations were included. In most patient contacts, patients did not report an increase in symptoms (n = 840; 44.7%). Fatigue, restlessness/anxiety, pruritus, and pain were the most recorded distressing symptoms. The chi-square test revealed that increased symptoms led to significantly more frequent interventions. Overall, symptom relief was observed at follow-up. Analysis using Generalised Estimating Equations showed patients benefited significantly from interventions for sleep disorders. Subgroup analysis showed that patients in ongoing therapy benefitted significantly from interventions for pain and nausea. Those in advanced disease stages benefitted significantly from interventions for pain. In those groups, if symptoms were explicitly stated as having worsened using the questionnaire, measures taken by physicians also showed significant benefit for obstipation and nausea along with pruritus. Conclusions: Targeted symptom screening is feasible and provides valuable insights for guiding diagnostic or therapeutic interventions. However, the questionnaire is most useful at higher tumour stages, as it is only effective when distressing symptoms are present. Full article

The use of radiotherapy in oncology patients aged 80 years and older represents a significant clinical challenge due to the limited availability of prospective data and the under-representation of this age group in clinical trials. Most existing evidence originates from retrospective analyses of small patient cohorts. Radiotherapy remains a cornerstone of cancer treatment, providing both curative and palliative benefits. Technological advances, including intensity-modulated radiotherapy (IMRT) and stereotactic body radiotherapy (SBRT), have significantly improved treatment precision, reduced toxicity, and enabled the adoption of hypofractionated regimens. These shortened treatment schedules are particularly advantageous for older patients, reducing the burden of prolonged therapy while maintaining therapeutic efficacy. Comprehensive Geriatric Assessment (CGA) plays a crucial role in optimizing treatment decisions for octogenarian patients by addressing their clinical, functional, and psychosocial needs. However, the routine use of CGA remains limited due to logistical and time constraints. Despite these challenges, current evidence suggests that radiotherapy is generally well tolerated in this population, with acceptable toxicity profiles even among frail patients. As the global population of individuals aged 80 years and older continues to increase, the development of specific clinical guidelines tailored to this demographic has become essential. There is an urgent need for prospective studies providing robust evidence regarding the efficacy, safety, and tolerability of radiotherapy in older adults. This review aims to summarize the current state of knowledge on the role of radiotherapy in patients aged 80 years and older and to highlight the need for evidence-based, individualized oncologic care for this growing patient population. Full article

Background: This study was conducted within the Qassim Health Cluster as part of efforts to operationalize the Saudi Model of Care (SMoC). It aims to evaluate the outcomes and value of palliative care services in alignment with SMoC by applying patient-centered measurement tools. In Saudi Arabia, Vision 2030 has spurred significant expansion in palliative care, yet challenges persist in home-based care and consistent outcome measurement. Current Quality-Adjusted Life Year (QALY) methodologies often fail to capture patient-centered dimensions (emotional, spiritual, and social support), leading to gaps in outcome assessments. Methods: This cross-sectional descriptive study characterized 147 oncology palliative care patients in Qassim, Saudi Arabia, from January to December 2024. Data on demographics, diagnoses, care duration, health-related quality of life (EQ-5D-5L), and patient experiences were collected via face-to-face interviews. Although QALY was conceptually referenced, the study utilized EQ-5D-5L as a proxy measure for patient-perceived health status. Results: The cohort was predominantly older females (64.63%) with various cancer diagnoses, primarily breast cancer (29.25%), and a long duration of palliative care. Patients reported significant impairments in mobility (21.77%), self-care, daily activities, and a high prevalence of pain and anxiety/depression. However, most felt respected by their care team (85.71%), experienced effective symptom management (68.03%), and were consistently involved in decision-making (68.03%). Conclusions: This study provides baseline data on oncology palliative care in Qassim, highlighting complex patient needs alongside positive perceptions of care. QALY methodologies must be refined to better capture patient-centered benefits and inform resource allocation, contributing to more responsive and effective palliative care services. However, due to the cross-sectional design, causal relationships between care exposure and outcomes cannot be inferred; hence, the findings should be interpreted as descriptive rather than causal. Full article

Background/Objectives: Patients with incurable cancers enrolled in early phase clinical trials often face uncertainty about prognosis, yet advance care planning (ACP) is frequently delayed. The objective of this study was to assess the documentation of ACP discussions among patients enrolled in early phase oncology trials. Methods: We conducted a retrospective review of electronic medical records for all adults enrolled in early phase clinical trials at a single Australian institution (2012–2021). Data included time from metastatic diagnosis to first ACP discussion, clinical and sociodemographic factors, triggers for discussion, and clinician specialty. Results: Among 170 patients (58% male; median age 65 years), ACP documentation was identified in 109 (64%). ACP was most often initiated within the final year of life (73.8%), with a median interval of 23.5 months from metastatic diagnosis to first documentation. Common triggers were disease progression (39.6%) and hospital admission (37.8%). Discussions were typically led by the treating oncologist or trials specialist (43%) and palliative care physician (37.8%). The most frequently documented topic was the limitations of invasive care such as intubation (60%). Conclusions: ACP documentation was present in two-thirds of patients enrolled in early phase clinical trials, typically late in the disease trajectory. Integrating structured, earlier ACP discussions into oncology pathways would improve alignment of care with patient goals and enhance end-of-life care. Full article

Background: The intersection between oncology and intensive care has shifted from predominantly end-of-life care to a therapeutic bridge that can preserve anticancer trajectories in carefully selected patients. Yet, criteria separating benefit from futility remain fragmented. Objective: This paper seeks to map contemporary evidence (2015–2025) on outcomes after Intensive Care Unit (ICU) admission in adults with cancer and to identify clinical constellations in which ICU-level care still changes prognosis. Methods: PRISMA-ScR scoping review (PCC framework). PubMed search (2015–2025), dual screening, standardized extraction; narrative/thematic synthesis across six clusters (hematologic, solid tumors, sepsis/non-COVID-19 infection, COVID-19/viral pneumonia, novel/targeted-therapy toxicities, end-of-life/aggressive ICU) were used. No meta-analysis given heterogeneity. Results: Seventy-three studies (>170,000 ICU admissions) were included, mostly cohort designs across 27 countries. ICU mortality ranged 8–72% (weighted mean ≈ 41%); hospital ≈ 38%; 90-day ≈ 46%; 1-year ≈ 62%. About one third of ICU survivors resumed systemic therapy. Benefit concentrated in early admissions, single-organ failure, controlled/remission disease, postoperative/elective monitoring, and reversible treatment-related toxicities (e.g., ICI pneumonitis, CAR-T CRS/ICANS). Futility clustered around ≥3 organ supports, RRT > 7 days, refractory/progressive disease, and ECOG ≥ 3. Sepsis outcomes averaged 45–55% ICU mortality but improved with rapid recognition and source control; COVID-19 mortality was particularly high in hematologic malignancies early in the pandemic, with subsequent declines post-vaccination. Conclusions: In modern oncologic practice, ICU care changes prognosis when the acute physiological insult is reversible and cancer control remains plausible; conversely, high organ-support burden and refractory disease define practical futility thresholds. These signals support time-limited ICU trials, earlier ICU involvement for sepsis/irAEs, and embedded palliative care to align intensity with goals. Full article

Discontinuing active oncological treatment and initiating palliative care is a critical moment in cancer care, requiring oncologists to address complex clinical, ethical, and emotional challenges. This narrative review aims to provide clinicians with practical guidance for conducting conversations about treatment discontinuation and transitioning patients to palliative or hospice care. Drawing from current clinical guidelines, empirical research, and expert perspectives, the article reviews evidence-based communication strategies and frameworks, including the SPIKES protocol, Ask–Tell–Ask, the WHO model, and the disclosure model. The article also explores the clinical, functional, psychosocial, and ethical criteria relevant to treatment withdrawal decisions, as well as the timing and structure of end-of-life discussions. A practical algorithm is proposed, synthesizing key principles into a step-by-step guide for use in daily oncology practice. The algorithm supports clinicians in balancing medical indications with patient values and preferences, fostering shared decision-making and maintaining therapeutic relationships even in the most difficult circumstances. The review concludes that structured yet flexible communication enhances patient understanding, reduces unnecessary interventions, and improves the quality of end-of-life care. By promoting patient-centered care and timely palliative integration, this article offers oncologists a clear and adaptable approach to one of the most sensitive aspects of cancer care. Full article

Cancer-related pain remains one of the most frequent and burdensome symptoms in oncology, significantly impairing patients’ quality of life and functional status. Despite advances in treatment and the availability of evidence-based guidelines, pain continues to be undertreated worldwide. In Italy, legislative efforts such as Law 38/2010 have not fully translated into consistent clinical practice. On 28 March 2025, a national roundtable held in Rome, Italy, brought together experts from medical oncology, radiation oncology, palliative care, anesthesiology, and pain medicine, representing the main Italian scientific societies involved in oncology and supportive care, to examine the current status of cancer pain management and develop a consensus on actionable priorities. Four key gaps were identified: insufficient education and training of healthcare providers in pain management; fragmented care pathways and limited interdisciplinary integration; lack of clarity regarding professional roles; and challenges in implementing shared diagnostic and therapeutic care pathways (Percorsi Diagnostico Terapeutici Assistenziali). The roundtable proposed coordinated strategies to address these gaps, including expanding interdisciplinary educational initiatives and integrating pain management into undergraduate and specialty curricula; establishing local oncology orientation centers to provide joint, patient-centered assessments; promoting cross-specialty collaboration through congress sessions, educational activities, and practical workshops; and developing adaptable therapeutic frameworks to ensure standardized yet context-sensitive care delivery. This congress report formalizes a joint framework aimed at embedding pain management within comprehensive cancer care. Its implementation will require sustained advocacy, structured education, and alignment of clinical practice with policy support. By addressing these barriers through pragmatic, evidence-informed actions, the proposed strategies aim to optimize timely, integrated, and effective pain care, ultimately improving outcomes for patients with cancer. Full article

In this segment of the Palliative Care Unit case series, we introduce a patient with a long history of oncological treatments for recurrent breast cancer. After active treatments and a global control of the neoplasm, disease progression made the patient access different lines of chemotherapies, even asking for them in anticipation of a few advantages in the balance between benefits and risks. When the patient decided to permanently discontinue chemotherapy, she felt she had disrupted her values. Also, as a reaction to breaking bad news without estimating alternative paths, she considered her deteriorating condition as the sole criterion for assisted dying in another country. Could this be a self-consistent choice for this patient, so determined to find and pursue possibilities in treatment previously? Should this clue respond precisely to the patient’s needs? This contribution’s objective is to debate possibilities of patient self-determination and dignity at the end of life by integrating psychological support, palliative care, and legal–ethical awareness. This case study presents multidisciplinary team work through some key turning points. This team work was carried out in a national context that is currently inconclusive regarding assisted suicide, since active euthanasia is illegal. At the same time, the national Constitutional Court (242/2019) recently opened the possibility of eventual medically assisted suicide under certain circumstances. In this case, health professionals considered this context and tried to delve deeply into respecting the patient’s identity in order to determine when and if the exceptional circumstances were met. This case highlights the ethical sense of end-of-life accompaniment, which when conducted by physicians, nurses, and psychologists together can lead to effective support and allow patients to maintain their identity and to express themselves respecting not only their fears but also their vision of themselves as human beings. A first key turning point was, for instance, taking into account the patient’s history and values, and a subsequent one was supporting the patient in exploring healthcare services and related end-of-life support. In a further key turning point, the patient was helped in engaging with physicians in order to understand types of continuous care, as well as the timing and expected results of sedation. Finally, she chose a healthcare service where she could spend the end of her life in fulfillment of her values. Overall, this case report illustrates how integrating psychological support, palliative care, and legal–ethical awareness can promote patient self-determination and dignity at the end of life. Full article

Background: The American Society of Clinical Oncology (ASCO) established recommendations for palliative care (PC), and they still remain the most trusted source overall. The standard published by C. Earle (defined in solid tumors) for referral to PC is > 55%. However, these rates remain unclear in general onco-hematology. Our referral rate reaches 60%; while it meets the standard, there are significant differences between ST and HM. Several authors have already pointed out these discrepancies. Arguing in some cases its possible relationship with the different behavior of professionals with different pathologies. Objective: The primary objective of this work is to understand the role that PC plays in onco-hematology and to determine the profile of patients referred to PC. Therefore, the article aims to establish some recommendations related to the results of prevalent characteristics. Methods: The Mortality Subcommittee (MS) includes and registers in a database all cancer patients who died in hospital undergoing systemic anticancer therapy (SACT) in their last 30 days of life (SACT ≤ 30 d). PC, in turn, works on relieving symptoms related to the disease and the patient. To understand the impact of PC in the MS database patients, we reviewed the literature for symptoms related to palliative care activity. Subsequently, we selected some signs and symptoms, by consensus with our PC specialists, in order to add them to the MS database and register them retrospectively. We measured the percentage of patients who registered these symptoms based on the data found in their electronic records. The results include the comparison by group: between patients referred or not to the PC program (PCP), and between the pathologies ST and HM. We used the programming language R (version 4.2) in our statistical analysis, including the “compareGroups” package (version 4.6), applying the pertinent tests based on the distribution of the data. Results: We completed the records on the 1681 patients from the period 2020–2023. 59.4% were men, the average age was 65.5 years, and 73.5% had ST and 26.5% had HM. Patients with lung cancer predominate (28.5%), with 71% of them being in the stage IV, followed by leukemia (9.76%). 60% are in progression of their disease, and 77% have advanced disease (AD). The average therapeutic aggressiveness indicators were SACT < 30 d: 38.9% (ST: 33.4%; HM: 70.97%); SACT < 14 d: 16.36% (ST: 13.76%; HM: 31.56%); the change in therapeutic regimen was 22% (ST: 20.8%; HM: 25.1%). The referral rate to PCP was 59.7% (ST: 68.2% and HM: 36.3%). Late referral (PCP ≤3 days before death) occurred in 29.2% of all patients, being 29% for ST cases and 30.4% for HM cases. Regarding the recording of signs and symptoms: psycho-emotional and analgesia regimens (including opioids) are better recorded in the PCP group (p < 0.001); the more physical symptoms (dyspnea, bleeding, infections, and severe symptoms) do not present statistically significant differences, although the severe symptoms in the PCP group are more disabling (cerebral involvement, spinal cord compression, vertebral crushing). The number of bags of blood products transfused is significantly lower in the PCP group (average 6.9 vs. 12.7). The total number of symptom variables with significant statistical differences was 13 for ST and 8 for HM. Conclusions: In this cohort, patients visited by PC had a better record of psycho-emotional symptoms. We consider that patients who are in any of the following situations should be referred to PC: initial diagnosis of stage IV lung cancer, leukemia; patients with advanced disease; presence of pain requiring opioids; psychoemotional symptoms; need for >7 to 15 transfusions of blood products and, if there are disabling symptoms. PC improves professional interest in the psycho-emotional and fragility situation of these patients. According to our data (in terms of the number of variables with significant differences by pathology group), we observed that hematologists tend to take on palliative tasks more frequently than their oncologist peers, who delegate them to PC in order to have more time dedicated to their specific field. Full article

Background and Objectives: Some cancer patients in palliative care need to access intravenous administration of medications to relieve symptoms. Few studies have explicitly assessed the safety and feasibility of peripherally inserted central catheter (PICC) insertion at bedside in palliative care settings. In this study, we suggest the usefulness, safety, and feasibility of bedside ultrasound-guided PICC placement as a tool for improvement in the quality of life for patients in palliative and hospice care settings. Materials and Methods: The study population, with terminal cancer and admitted to a palliative and hospice care unit in the Veterans Health Service Medical Center, was evaluated (N = 150). The patients were divided into two groups based on the methods of PICC insertion: Group 1 (PICC at bedside, N = 75) and Group 2 (PICC in intervention room, N = 75). The two groups were matched for age, sex, the level of Eastern Cooperative Oncology Group (ECOG) performance status, and types of primary cancer. Results: The success rates of the PICC procedure for Groups 1 and 2 were 89.33% and 97.33%, respectively, with no significant difference between the groups (p = 0.102). The mean duration (days) of catheter use was longer in Group 1 (23.31 ± 16.36) compared to that in Group 2 (21.90 ± 18.95), with no statistically significant difference (p = 0.639). Multivariable logistic regression analyses confirmed that Group 1 was not inferior to Group 2 regarding procedural success (Model 2, p = 0.21) and catheter dwell time (Model 2, p = 0.66). The most common cause of catheter removal in both groups was death, followed by self-removal and hospital discharge (p = 0.386). Conclusions: This study suggests that ultrasound-guided PICC insertion at bedside may have comparable procedural outcomes with potentially reducing the risks associated with intra-hospital patient transport compared with fluoroscopy-guided placement. We suggest this bedside approach can be considered a feasible and safe method for improving the quality of life of patients in palliative care settings. Full article

Background/Objectives: Family meetings (FMs) are clinical encounters in a structured space between the patient, family members, and care teams. Healthcare professionals (HPs) often lack formal training in conducting FMs. The scoping review aims to provide an overview of the available research evidence on FMs’ education for HPs. Methods: We searched MEDLINE, Embase, CINAHL, PsycINFO, and Scopus. The PCC (Population-Concept-Context) framework was used to define inclusion criteria: educational intervention on FMs aimed at HPs in all settings of care and students of medicine and nursing sciences treating adult patients with oncological and non-oncological diseases. Results: The search retrieved 1017 articles, of which 26 were eligible. The training had as its primary aims the development of communication skills and curriculum development/evaluation. For the most part, palliative care physicians served as trainers, while medical students and residents represented a major part of trainees, underscoring a focus on early-career learners. FM training is mainly provided in the American countries and intensive care settings. Role-play or simulation was the most common teaching method. Pre- and post-interventional designs were the most common, with few studies incorporating longitudinal follow-up to assess skill retention. Quantitative and qualitative methodologies were used to evaluate interventions. Conclusions: The training topics are related to advanced communication, but there is a lack of an interprofessional perspective and long-term assessment of the skills learned. It is necessary to consider different family types as subjects of communication. Full article

Background: Glioblastoma is an incurable form of brain cancer with a median overall survival of 1.5 years. Despite its progressive nature and high symptom burden, palliative care is not consistently integrated in routine glioblastoma care. Early integration of palliative care better addresses the needs of patients and caregivers, improves quality of life, and reduces inappropriate care in the end-of-life phase. This study aims to design an integrated care pathway to support the early integration of palliative care for patients with glioblastoma. Methods: We used a design thinking approach, engaging stakeholders from neuro-oncology, specialist palliative care, primary care, district nursing, healthcare administration, health insurance, health economics, and patient advocacy. The process consisted of thirteen informal interviews (with healthcare professionals, patients, and caregivers), six expert meetings, and two workshops. Results: First, we mapped existing routine glioblastoma care and identified perceived barriers to early palliative care integration, including variations in advance care planning (ACP) timing, clinicians’ hesitation, unclear referral criteria to specialist palliative care, suboptimal care coordination, and limited experience with glioblastoma in the primary care setting. Second, iterative prototyping led to the development of a care pathway with key components: initiation of ACP by the lead clinician within six weeks of diagnosis, integrated multidisciplinary team meetings for complex cases, ongoing coordination, clear referral triggers for specialist palliative care, and structured caregiver care. Conclusions: The co-designed pathway provides a feasible model for integrating early palliative care into routine care for patients with glioblastoma. Future steps include implementation and evaluation of the care pathway and development of a payment model. Full article

Introduction: Cancer is one of the evils of the current era and is considered a global public health problem. This disease has repercussions for the lives of patients in several dimensions, namely, physical, emotional, and psychosocial. Thus, it is believed that elements such as resilience, symptomatology, and self-care are related, as the disease and its treatments can have repercussions that extend beyond the clinic. Background/Objectives: We aimed to determine the relationship between symptom clusters and the mindful self-care of people with cancer in palliative care. Methods: This is a cross-sectional study conducted with 125 palliative care patients diagnosed with malignant neoplasms. The research was carried out at a reference hospital in Brazil, located in the western region of the state of Santa Catarina, specializing in antineoplastic treatment. The data were collected between May and August 2023 from hospitalized patients. Three instruments were employed to obtain data: a sociodemographic and clinical data questionnaire, the Edmonton Symptom Assessment Scale (ESAS-BR), and the Mindful Self-Care Scale (MSCS). For data analysis, descriptive statistics were used to characterize the participants, Student’s T-test was used for the other parametric tests, and variables with statistical evidence were selected for a linear regression model. Results: A statistically significant association was found between mindful self-care and symptoms of pain, tiredness, drowsiness, shortness of breath, depression, and malaise, with sleepiness being the only predictor of changes in this variable. Conclusions: Mindful self-care influences patients’ experience of symptoms, especially drowsiness, which predicts changes in self-care. Encouraging these practices reduces discomfort, enhances autonomy, and guides professionals in personalized care. Full article